Kevin, M.D. - Medical Weblog

Hey, your job is to prescribe/provide optimal treatment. Who pays and how much is the patient's business.

Docs really need to get out of gatekeeping expenditures and get back to being doctors.
 

I'm not certain that Kevin said anything about gatekeeping.

That role however has been forced upon us by our patients. Because 'insured' patients are not insured by a private contract between themselves and an insurer, but rather through a contract that exists between their employer and a medical payment company. The so called insurance company is not really an insurer, as they face no risk of loss; this is born by the patient's employer who's monthly payment to the 'insurance' company fluctuate with employee expense. Meanwhile the insurance company, with no real risk or true exposure, takes a cut for managing the paperwork between the pharmacies, doctors, hospitals and the employer paying for the whole thing. I'm certain it's even more complicated than this simple understanding; I've never really read the whole of any contract I have with insurers to provide care for their patients. Anyway, the doctor is working for and contracted by the employer through the insurance company and is obligated to gatekeep as part of this fiscal contract.
The physician is always in a conflict of interest when dealing with insured patients.

Fortunately, most of the time we do think of what's best for the patient, as they are physicallly present representing themselves, and the insurance company has no Big Brother physical presence in the exam room (yet.)
 

Uh, let's see. The survival advantage is 84 percent vs. 81 percent.

This study involved 8,000 women and two years of data. I see it was financed by Novartis, the manufacturer of Femara.

I just don't see that this is any huge breakthrough. I personally would want to see a much more significant survival advantage and more years of data before I could say, yeah, the cost is justified.
 

From the CNN article: "The published study, reported earlier this year in Europe, estimated that 84 percent of women given Femara versus 81 percent of those on tamoxifen would be alive without any signs of cancer five years after starting treatment.

The estimates were based on roughly two years of information on relapses among the 8,000 women in the study, done by researchers in the United States, Europe and Australia."

So, 84 vs 81% aren't even real data; they're estimates of results at 5 years, based on 2 years' worth of data. Is this science? Apparently, the FDA thinks so.

What's sad is that the general press will trumpet stuff like this, and once again women will think there's some grand progress being made in fighting breast cancer.

BTW, I agree with gasman's assessment of the role that a doctor plays in the contract with employers. It's employers who ultimately decide what will be covered, and what won't; insurers are just their handmaidens.
 

"Hey, your job is to prescribe/provide optimal treatment. Who pays and how much is the patient's business."
Not true. If I prescribe an expensive medication to a patient who can't afford it and then turn my head in the other direction, I am a bad doctor. My goal is to find the best realistic treatment that will have results and that means I have to consider also the cost.
 

It's not the doctor's job to describe what's "realistic" for the patient; only the patient can do that. The doctor should provide options, including information on both cost and effectiveness of different medicines, so the patient can make a decision based on her particular situation. Doctors deciding what is "realistic" for patients smacks of that age-old paternalism thing that is so repugnant.